APPENDICITIS

Clinical Features

  • Starts classically with diffuse abdominal pain felt most prominently in the periumbilical area.
  • There is anorexia and nausea.
  • Vomiting may follow.
  • Pain then settles in the right lower quadrant and is localized at McBurney’s point.
  • The pain may be relieved briefly after perforation but is accentuated by the ensuing diffuse peritonitis.
  • There is localized tenderness in the right lower quadrant,
  • Rebound tenderness
  • Muscle guarding
  • Cutaneous hyperaesthesia
  • Pelvic tenderness in the right iliac fossa on rectal examination.
  • Rovsing’s sign may be positive and the temperature may be elevated.

Investigations

Laboratory examinations are not critical for diagnosis. There is leucocytosis with neutrophilia. Normal values do not rule out appendicitis, however.

Management

  • Initiate appropriate resuscitation.
  • Once diagnosis is made, give analgesics whilst preparing for surgery.
  • Starve the patient before surgery
  • Give premedication when there is time (atropine 0.6mg IM stat and morphine 10mg IM stat).
  • Appendectomy is the treatment of choice, once a definitive diagnosis is made.